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This is VAERS ID 275225

Case Details

VAERS ID: 275225 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2007-03-21
Onset:2007-03-21
   Days after vaccination:0
Submitted: 2007-03-28
   Days after onset:7
Entered: 2007-03-30
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / UNK LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2141AA / UNK RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Blood glucose, Dizziness, Electrocardiogram normal, Fall, Head injury, Headache, Muscle twitching, Pallor, Staring
SMQs:, Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: allergies - Erythromycin, Acanthosis nigricans, overweight
Allergies:
Diagnostic Lab Data: Accucheck 149, via normal EKG normal $g Done at medical center
CDC Split Type:

Write-up: Received immunizations at approximately 6:50PM, went to waiting room where brother and sister saw her fall to floor hitting her head (?left side) on a wooden playbox. They said she just stared for about 5 seconds then left arm / shoulder was twitching when RN arrived, patient was conscious and in a chair. She was pale, P68 at a FBV minutes, before 7pm, BP was 108/78, P78 standing. She was still dizzy and c/o headache, so ambulance was called. She was observed in ER and discharged home.


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